Orthobullet Tests Flashcards
1
Q
Congenital Dislocation of Knee
A
Start with casting in flexion(4w)–>open procedure to quadriceps. THough to be quadriceps contracture
2
Q
Short Head of Biceps Femoris Innervation?
A
Peroneal Division of Sciatic N.
All other hamstrings get from tibial division also both heads of gastroc
3
Q
Botulinum Effect?
A
Decrease Release of Acetylcholine at NM JXN (pre-synaptic)
4
Q
Myasthenia Gravis
A
Ig’s against acetylcholine receptors at NM JXN (post-synaptic). Tx acetylcholinesterase inhibitors and Thymectomy. Easy fatiguabilty, ptosis with upwards gaze
5
Q
Dystrophin Effect?
A
acts to regulate CALCIUM influx at level of sacrolemma
6
Q
Yield Point
A
Point on Stress/Strain when material goes from elastic behavior to plastic behavior
7
Q
Terrible Triad?
A
Posteriorlateral elbow dislocation (LCL)
Coronoid Fracture
Radial Head Fracture
8
Q
Aminoglycosides MOA?
A
30S Ribosomal Sub-unit
9
Q
Penicilllin MOA?
A
Prevent bacterial cell wall synthesis
10
Q
Macrolides MOA?
A
50S ribosomal sub-unit binding
11
Q
Rifampin MOA?
A
inhibit RNA polymerase
12
Q
Quinolones MOA?
A
DNA gyrase inhibition
13
Q
With Knee Flexion Tibia/Femur Rotation?
A
Relative internal rotation of tibial about medial point, Relative lateral rotaitn of femur
14
Q
How does distal lateral femur translate during knee flexion?
A
Posteriorly
15
Q
Arthroscopic Lysis of adhesions considered ?
A
Usually after MUA failed for ROM, no infection, AFTER 3 months
16
Q
Common problem after TKA revision?
A
Elevation of joint line (even with NL Flex/Ext gaps) need to augment femoral component
17
Q
Snowboarders fracture?
A
Fracture of lateral process of talus (casting - ND, ORIF- displaced)
18
Q
MSIS Major Criteria PJI
A
- Draining Sinus Tract
- Pathogen Isolation from 2 different samples
- 4 or 6 minor criteria
19
Q
MSIS Minor Criteria
A
- ESR >30, CRP >10
- WBC >1,100 (synovial)
- Elevated PMN synovial WBC >70%
- Purulence in Joint
- > 5 PMN per HPF
- Organism isolated from 1 sample
20
Q
Most common risk factor for humeral shaft non-union?
A
Vit D Deficiency
Tx: Compression plating and bone graft
21
Q
Femoral Resurfacing vs THA
A
Better femoral bone stock preservation, High re-operation rates (loosening and femoral neck fracture), wear rate is same of both MonM
22
Q
Acetabular Liner REvision associated with?
A
High dislocation rates
23
Q
Ipsilateral Femoral Neck and Shaft Fractures treatment- Highest rates of mal-reduction?
A
Treatment with one implant: should use two separate implant devices
24
Q
Patellectomy TKA?
A
lack of levear arm with patella decrases rate at which patella tendon prevents tibia from A–> P translation, stretched PCL/posterior capsule overtime (recurvatum), need to due Posterior substituting knee
25
Meniscus injury Risk Factures in Shatsker II
Joint depression >6mm
| Joint Widening > 5mm
26
Remelting Versus Annealing?
Remelting removed MORE free-radicals but disrupts crystalline structure more. Therefore annealing has MORE free radicles but BETTER mechanical properties
27
Total Elbow in Elderly for complex distal humerus fracture?
- Better outcomes
- Better ROM
- Decreased REvision rates compared to ORIF
Cant lift more than 5-10 lb
28
Most common place for TB in spine?
Usually starts anterior, sparing of the disk space.
29
SSEP's vs MEP
- SSEPS- not good at monitoring anterior spinal pathways, NOT effected by Anesthesia
- MEPS more sensitve and specific, CAN be effected by anesthesia
30
Most common site for vertebral TB in children?
anteiror aspect of lower THORacic spine. Usually DOES NOT violate endplate like bacterial infections do
31
Corticosteroids inhibit inflammatory process via inhibition of :
Phospholipase A2
32
Two types of CRPS?
1. Reflex Sympothetic Dystrophy: no nerve lesions
| 2. Causalgia: may have assocaited nerve lesions
33
Middle glenohumeral ligament orientation to SS tendon when veiwing from posterior portal?
Crossed the posterior aspect of SS at 45d angle to insert on superrior labrum or glenoid
34
Vaughan-Jackson syndrome tendon ruptpure?
- attritional wear of the extensor digiti quinti tendon with rupture
35
EIP in the 4th dorsal compartment ?
is ULNAR and DEEP to EDC
| - EIP has most distal muscle belly
36
Pseudogout clinical apppearance?
weakly positive bifringent: blue
| - Chondrocalcinosis: articular cartilage and meniscus
37
IOM from radius and ulna?
- Central band and acessory bandrun from proximal radius to distal ulna orientation. All the other OLIBUE chords and band run from ulnar proximally to radius distally.
38
Keller Resection Arthroplasty patient?
- Lower demand
- NO dorsiflextion of proximal phalanx
- Loss of motion, significant joint degen
- removal of base of proximal phalanxx
39
Modic Type I Changes:
T1 Low, T2High signal(represented bone edema and inflammation)
40
Modic Type II (T1/T2)
```
T1 High (conversion to fatty marrow
T2 High
```
41
Modic Type III (t1/T2)
T1 low, T2 Low- sclerosis
42
Weil shortening osteotomy:
MT shortening and plantar displacement of MT head. Should be made parallel to plnatar surface of foot to decrase likelihood of KONWN dorsiflxion deformity of MTP
43
Asia B injury (motor/sensory)
- INCOMPLETE (perianal sensation/rectal sensation, sensation distal to level of injury
- Some Sensory
- NO MOTOR
44
Tarsal Navicular Stress Fracture Treatment:
Cast immbolization/ NWB
| - Usually DX on CT (not seen on PFs)
45
Oblique diaphyseal rotational osteotomy of MT indications?
bunnionette deformity with IMN of 4-5th GREATER than 12degreess
- for 7-12d you can do medializing chevron osteotomy
- for less than 7d just do chielectomy
46
Adult spinal deformity extension of contruct to sacrum (benefits/complications)
- improved saggital balance
| - increase pseudoarthrosis
47
When does cauda equine need to be decompressed ?
Within 48 hours - no difference in outcomes if sooner
48
Treatment of Hallux rigidus in older, low deman patients?
keller resection arthroplasty- removal of proximal portion of proximal phalanx, osteophyte removal
49
Mortons Extension Orthosis:
- Limits the extension of 1st MTP during push off of gain
| - used for hallux Rigidus, TURF Toe
50
What does release of conjoined tendon in great toe do?
- Hallux varus
| - formed by lateral tendon of FHD and adductor hallicus
51
Potts disease progression:
- TB of the spine (preferential anterior thoracic in children, leave endplates alone
- Adults does NOT progress after disease
- Children (40 ) will progress after resolution of disease
52
Acute Spinal chord injury steroid dosing
LOADING DOSE: 30mg/kg +5.4mg/kg/hr
<3 hours from presentaiont- for 224 total hours
3-8 hours: for 48 total hours
>8 hours- NO STEROIDS
53
Hallux rigidus secondary effects
- decrease dorsiflexion
- transverse metatarsalgia/stress fractures
- inverted gait due to decrease dorsiflexion
54
Critical Lumbar Stenosis measurements?
- <10mm on AP
| - , 100mm2 on cross section on axial CT
55
C1 lateral mass screw trajectory?
10d medial
| 22c cephalad
56
Anterior Tarsal tunnel syndrome:
Radiation to dorsal 1st web space
| - compression of DPN in the anterior tarsal tunnel
57
Most common location of Mortons neuroma?
between the 2-3rd MT heads, transverse intermetatrsal ligament
58
Baxters Nerve?
1st branch of lateral plantar nerve. May have tinels aat plantar medial heel with pain that radiates to 5th toe
59
Flexk sign lateral to fibula?
pathonogmonic for superior peroneal retinaculum and peroneal dislocation: PT->then may repair/tenodesis
60
Most common site for DPN entrapment?
THe inferior extensor retinaculum
61
Cavus Muscle Imbalances:
TA weak, Peroneal Longus Strong
| Posterior tib stron, peroneal brevis weak
62
Cavus Foot deformity:
- cavus
- Hindfoot varus
- Forefoot pronation
Coleman block determines flexibility of hindfoot
63
Non flexible hindfoot in cavovarus?
Will need cacl osteotomy
64
"Floating toe deformity"
- Usually due to Weil osteotomy used for metatosalgia.
65
Cavovarus foot correction algorithim and coleman blcok:
- ID's supple hindfoot or not- tell you if the cavus is driven by 1st ray or NOT. IF it corrects with block then driven by 1st ray, would correct with dorsiflexion osteotomy
66
Resection of Tibial sesamoid?
Hallux Valgus
67
Resectin of Fibular sesamoid?
Hallux Varus
68
Resection of both sesamoids?
cock up toe deformity
69
Large DMAA (>10)?
Needs BIPLANAR chevron rather that normal chevron distal osteotomy
70
Hallux Valgus Interphalangenous?
- >10d
| - needs Akin (medial closing wedge) osteoetomy of proximal phalanx
71
For joint inconcruence in hallux valgus, what does it need?
Distal soft tissue correction as well
72
PTTI- acquired adult flat foot deformities?
- Hindfot valgus,
- Forefoot adbduction
- Forefoot Varus
- Planus
- Mearys >4, Decrease calcaneal pitch, Decrase medial cuneiform floor height
73
PTTI Stage IIA
- Flatfoot
- NO Single Leg raise
- Flexible hindfoot
- NORMAL Forefoot
74
PTTI IIB
- Flatfoot
- no SLR
- Flexible HIindfoot
- FOREFOOT ABDCUTION
75
RIGID hindfoot in PTTI indicates what intervention?
Need for arthrodesis
| - Usually TRIPLE
76
Acessory muscle/tendon in peroneal tendon sheath?
Peroneous Quartus- may be found in up to 21% of patients, increases volume of sheath
77
What type of receptors activate the NF-kB pathway?
Toll-like receptors
- Leads to production of MMPs
- Stromelysins subgroup of mMPs
78
Pathologic Scoliosis causes?
- Osteoid osteoma (<1cm)
- Osteoblastoma (>1.5cm)
- Curves usually RIGID, occurs at APEX of deformity
- osteoblastoma more likely to have neuro copromise (size)
- Usually in posterior elements
79
Pediatric Spinal Tumors and their locations?
- Osteoid Osteoma- Posterior elements
- Osteoblastoma- Posterior elements (>1.5cm)
- Osteochondroma (PE, more cartilage
- Osteogenic Sarcoma- PE
- ABC- vertebral body
- Eosiniphilic granuloma- Cervical- vertebral body
80
What is best predictor of AIS curve progression?
peak growth velocity:
- occurs in females jest BEFORE menarche and Risser Stage I
- GIrls usually skeletally matrue 1.5 years after menarche
81
Increase kyphosis, chin on chest, increased chin-brow-vertical angle?
Ankylosis spondylitis
- May need PSO (30-40d correction per level)
- Vertebral resection
- C7-T1 osteotomy
- Chin on chest needs C7 pedical removal (Posterior extension osteotomy)
82
Prolonged delivery, lack of shoulder adbuction or ER?
Brachial plexopathy from birth
- Erbs better prognosis than Klumpke's
- Erb's- Upper nerves 5/6
- Klumpke's- lowers8/T1
(have glenoid retorversion, posterior subluxation
- may nee Lat transfer, humerusER osteotomies- late disease
83
What is a Putti sign?
compensatory scapulothorasic motion to ADDUCT the arm resulting in prominence of the superiormedial border of the scapula
84
Adult Halo traction?
4 PINS at 6-8lbs of traction
- safe zone is 1cm above and lateral 2/3 of orbit
- most common complication is CN VI _lateral rectus
- M->Supratrochlear-->Supraorbital->Lateral
85
Cascade of superior facet facing in subaxial spine?
Goes from posterior medial in cephalad regions to posterior -lateral is caudal regions
86
Flattened Facies, multiple joint dislocations, ligamentous hyperlaxity?
Larsens Syndrome
- radial head, knees are common dislocations
CERVICAL KYPHOSIS must be watched
87
Chances of motor recovery of infant with total brachial plexus palsy AND Horners syndrom?
<10%
88
Administration of BMP-2 at time of definitive fixation for Type IIIA and IIIB tibia fractures has shown what?
decreased risk of future bone grafting procedures needed
89
Spondylolisthesis not seen on initial plain films, what is most sensitive study?
Bone scan with SPECT
90
What are the joints WITH intra-articular metaphysis?
Hip, shoulder, elbow, ankle
| NOT the KNEE
91
What is Type I Muscle?
- Slow twitch, needs O2, Aerobic, endurance
| - Endurance training increases capillary denisty
92
Strength training does what to muscle units?
- increase recruitment
| - hypertrophy>hyperplasia
93
Outerbridge classiciation
```
0- Normal Cartilage
1- Cartilage Softening and swelling
2- Fissues on surface that do NOT rach subchonral bone
3- Fissuring to subchondral bone
4- Exposed subchondral bone
```
94
Transcription factors that lead to osteoclastogenesis?
RANKL
| MCSF
95
Where is most common locations of osteochondritis dessicans lesion?
MFC
| - Doesn't always involve cartilage, primarily lesin of subcondral bone, best predictor is open physis for recover
96
What is most specific marker of osteoblast maturity?
Osteocalcin:
97
Percutaneous Screw Fixation for femoral neck stress fracture indications?
- Tension sided fractures
| - Compression sided fractures that extend >50% across neck
98
Sausage digit, nail pitting, "pencil in cup" diagnosis?
Psoriatic arthritis
99
What Risser Stage does Peak Growth Velocity Occur in?
Risser Stage 0
| - Olecranon fuses before initiation of Risser I-->5
100
What is the main bood supply of the ACL?
Middle geniculate artery- branches from popliteal
- PCL also from MGA (hemarthrosis)
- Lateral and medial mesnisci (from inferior medial/lateral geniculate arteries)
101
Rhuematoid arthritis ?
- Periarticular erosions, symmetric joint degen, no osteophytes
- Protrusio acetabuli, spares IP
- MCP degen, ULNAR drift--> late disease get MCP arthroplasty
102
Absolute contraindication to meniscal transplant?
- Varus mal-alignment
- ACl deficient
- Grade IV chondromalacia
- inflammatory arthritis
103
ACL is primarily composed of what type of collagen?
90% TYPE I
| - Dupuytrens contracture? Type III
104
Enzyme in alkaptonuria (ochronosis)?
Homogentisic acid oxidase
- early arthritis , blackened on gross spec
- dark urine
105
What molecule responsible for water content in nucleus pulposis?
AGGRECAN(ketarin and chondroitin sulfate)
- major contributor to COMPRESSIVE strength
Nulceous pulp: type II collagen- tensile strength
Annulus- Type I collagen- tensile strength
106
Zone of cartilage"
Superficial: collagen PARALLEL to JOIN- LOW Proteoglycan
Intermedia: Random
Deep: Perpindicular to joint, HIGH Proteoglycan
Tidemark
107
With a retorverted pelvis, what would be tight?
Hip flexors and hamstrings
| - can be seen in hyperlordosis of spondylolisthesis
108
Statistical Power Definition: finding as significant association when one truly exist-->formula
often set at 80%
- Type II error= incorrectly assuming th NULL hypothesis (there is true difference but you reject it)
Type I error: incorrectly REJECTING the null hypothesis
109
Discoid meniscus surgery indications?
- persistent pain or MOTION loss
110
What is the lung met potential of giant cell tumor of bone?
4%
111
What are the signs of rheumatoid cervical spondylitis?
- Basilar invagination
- Subaxial instability
- atlanto-axial subluxation
112
What is classic appeareance of vertebral hemangioma?
vertical striations in the vertebral body seen on saggital (on axial imaging would be boney spots)
113
Langerhan's histocytosis stain?
CD1
| - birbeck ganules seen in cells
114
Cancellous and cortical bone remodeling?
- Cortical- cutting cone, osteoclastic tunneling
| - Cancellour/Trabecular Bone ( Osteoclastic resorption)
115
Cervical Stenosis Values?
>13 nl
10-13mm- relative stenosis
<10mm absolute stenosis
Torg Ratio: <0.8 (canal/cervical body) -saggital
116
What is the most common child-hood SOFT-tissue sarcoma?
Rhabdomyosarcoma
117
Cohort versus case control study
Cohort- has risk and look to see disease
| Case /Control- has case/disease- look back to see risk
118
What is cascade of YOungs modulus?
1. Ceramic
2. Alloy (Co-Ch)
3. Stainless steel (iron-carbon allow, molybdenum, Mg)
4. Titanium
5. Cortical Bone
7. PMMA
Cancellous bone
Tendon/ligaments/cartilage
119
Differential of Small, round, blue cell tumors?
- neuroblastoma -<5yo
- ewings sarcoma 5-15yo
- Langerhans cells
- lymphoma 15-40yo
- Myeloma
- small cell lung carcinoma
120
ZPA
| AER
Sone of polarizing activity- Radial-ulanr growth
| Apical ectodermal ridge:- logitudnal growth
121
Synovial Cell Sarcoma appearance nad translocation
- Biphasic
| - X-19
122
Weinstien Group II
Cerebral palsy scoliosis with >15d of pelvic obliquity
| - instrumentation to pelvic decrease late re-curreance and pseudarthrosis . With pelvic obliquity <15d can stop at L4/5
123
Indications for Mehta casting (derotational) in infantial scoliosis?
RVAD >20d
| Scoliosis >30d
124
What could increase pseudarthrosis risk in patients with surgical ADULT idiopathic scoliosis?
- Saggital balance > 5cm
- Thoracoabdominal apporach
- Age greater than 55
125
TLICS scoring value for surgery?
>4
Morphology (compression1, burst2, translation/rotation3, distration4
PLC: intact0, unsure2, out3
Neuro: normal, nerve root, incomplete 3, complete 2, cauda equina 3
126
Fusion of the olecranon apophysis occurs at what age and in what direction?
- Anterior to posterior
| - from 15-17
127
Ewings sarcoma Treatment?
| Translation?
11:22
CD 99 stain
CHEMO, RESECTION, RADIATION; all three
Chemos is Vincristine/Doxorubicin/Dapto
128
Osteosarcoma treatment algo?
Chemo (MTX) + Wide resection/amputation
129
What is most common site of metastasis for osteosarcoma?
LUNG>>Bone(second)
130
What does over-resection fo posterior femoral condyles in PS knee cause?
Flexion instability (without dislocation)
131
Atlantoaxial rotatory instability SCM relationship:
The CHIN will roate to side OPPOSITE of Facet subluxation of C1
- The SCM with we spastic 2/2 to that and be spastic on SAME side as chin
- in congenital torticollis, the SCM is spastic on OPPOSITE side of chin
NON-op fails-->C1/C2 fusion
132
What are the common organisms of CHRONIC PJI
- Coagulase Negative STAPH and Proprionibacterium
133
Pleomorphic Sarcoma treatment?
Chemo, WR/ chemo. Like osteosarcoma. WIll look like it in imaging but Histo will be spindle cells, no osteoid
134
What is the birfucate ligament in the foot?
Attaches to anterior process of the CALC to the Cuboid and navicular. Can cause boney avulasion fracture with pain on lateral aspect of foot
135
PTHrP does what at the physis level?
Slows the maturation of proliferating chondrocytes
136
Two sample T test vesus Mann-Whitney?
BOTH are for two MEANS
- Two sample T- Parametric data
- MW- NON-parametric data
137
Myxoid Liposarcoma translocation?
12: 16
| (2: 13)- alveolar rhabdomyosarcoma
138
What is FDA approved medicaiton for treatment of Giant Cell tumor of bone?
Denosumab
139
Treatment for Mulitple myeloma?
- Surgical stablization
- RADIATION
- BISphosphonates
140
Dabigatran MOA?
Direct Thrombin Inhibitor
141
Rivaroxaban MOA?
Direct Facot Xa Inhibitor
142
Heparin works via MOA?
Activation of antithormbin III (ATIII)
143
What is the severe form of Lanherhand Cell histiocytosis that invovled visceral organs?
Hans-Shuller-Christian disease
144
What spinal lesion is typical for Eosiniphillic granuloma?
Vertebra plana
145
Coast of Maine hyperpigmentation?
McCune-Albright syndrome
- Polyostotic fibrous dysplasia
- Precocious puberty
- endocrine distrubances
146
Anti CCP is a marker for what ?
Rheumatoid Arthritis
147
Side Effects
- Bleomycin?
- Doxorubicin?
- Bleomycin- pulmonary fibrosis
| - Doxirubicin: cardiomyopathy
148
Giant cell tumors are usually NOT found in patients with open growth plates
THink UBC or ABC
149
How long can you wait in ExFix in Femur? Tibia?
Femur- 3 weeks
| Tibia- 7-10days
150
Indications for Uni Arthroplasty?
- ACL competent
- , 10 d of mechanical axis off
- , 15 d of flexion contracture
- Non- inflammatory arthritis
151
Botulinum works at what portion of synapse?
At PRESYNAPTIC release of ACH
152
What do you haev to gt in JIA before surgery?
Cervical radiographs for instability
153
Where and when do Chondroblastomas occur?
Usualy epiphysiUsualydo NOT occur after PHseal closure
154
SNAC WRist Progression?
```
Scaphoid NON unioin advanced colapse
1. radioscaphoid/radiostyloid
2. scaphoid capitate
3. Pancarpal
RADIOLUNATE is usually fine
PRC for 4CF- Have to do 4CF is capitate head is fucked
```
155
Does volumtric wear rates in MoM hips follow typical increase in head size, increase in wear patter?
No because of incrase sliding speed in larger head
| - though to be comparable volumetric rates at 28 and 36 due to this
156
Wear rates are independent of femoral head size between what sizes?
28-42mm
157
Most common complications withTKA follow HTO?
1. Patellar Baja
2. Diffcult exposure
3. Instaiblity
158
Metabolic Syndrome constellation?
HTN
HLD
Glucose intolerance
Central Obesity
159
Stages of Perlunate dislocation ?
1. SL ligament
2. Luno- Capital articular
3. LT ligament
4. DRC ligament
160
Continuous Variables NORMAL distribution test?
Student t test
161
Continuous Varibles NON NORMAL distrubtion test?
Man Whitney U Test
162
Two groups of categorical variables?
Chi -Square Test
163
More than Two groups of variables
ANOVA
